Ian Mulgrew: 'Universality' sort of — no one else does Medicare this way

Doctors operate to remove a cyst from a patient's knee at the Cambie Surgery Centre, whose medical director — Dr. Brian Day — is leading a constitutional challenge of the B.C. Medicare Protection Act in B.C. Supreme Court.DARRYL DYCK / THE CANADIAN PRESS Files

Another expert testifying at the groundbreaking B.C. Supreme Court Medicare trial made it sound as if there is little hope of an honest public policy debate about health care reform.

Professor emeritus at the University of Western Ontario and a C.D. Howe Institute expert in health economics, Åke Blomqvist portrayed the national discussion as befuddled by Orwellian doublespeak and bedevilled by vested interests.

He claims leading developed countries in recent years have reformed their health care systems for the 21st century, while Canada remains mired in a rhetorical showdown.

“Deep but narrow,” is how Blomqvist described “universality” in Canada testifying at the constitutional challenge to B.C.’s Medicare Protection Act.

In other words, if you’re talking about financing hospitals and physician services, Blomqvist explained, Canada has nearly 90 per cent coverage, it’s deep.

But if you are talking actual “health care,” which involves drugs, dental, vision, mental wellness, long-term care, etc., we are laggards — we cover too narrow a range of services.

No other advanced country is following our approach — Blomqvist emphasized, and for decades he’s studied health care systems and their economics around the world.

By our approach, he meant: “The existing Canadian system — with not only its narrow but deep coverage with near complete coverage of hospitals and physicians but not universal coverage of pharmaceuticals and continuing care, which in many other countries is covered by the universal plans, and the characteristic of legislation in many provinces that effectively rules out the provision of physician services and the offering of private insurance outside of the framework of the provincial plans.”

Canadians spend a lot of money on health care and get middling results, in Blomqvist’s opinion — the provincial systems do not produce enough high-quality care for the amount of money spent.

From 1990/91 to 2013/14 total health care costs rose from 34 per cent to 41 per cent of provincial and territorial spending, he said.

Related

“Allowing competition from private alternatives is more likely to lead to improvements in the public system than to cause harm to the public system.”

Two private clinics and a handful of patients say the current law, particularly its restrictions on doctors practicing in both private and public spheres and on insurance plans providing coverage for necessary medical services, violates the Charter of Rights and Freedoms.

They argue the public system is not providing timely access to needed medical services and the legislation prevents patients from seeking private care or buying insurance to pay for the private provision of core services.

Blomqvist and a colleague did an in-depth comparison of Canada’s health financing system with the U.K., Australia, Switzerland and the Netherlands.

Each country provides universal access to needed health care, regardless of ability to pay, but all of the others allow a greater role for private medicine and private health insurance.

The U.K. and Australian systems give people more complete coverage for drug costs and all do better than Canada providing a broader spectrum of care.

The Netherlands and Switzerland use a very different model to achieve universality, he noted — a 19th century German-inspired system whereby many services are covered by insurance funded by employees and employer groups.

The passionate support of provincial health care systems puzzled Blomqvist in light of the many gaps in coverage.

His work suggests the large variation in provincial performance in international rankings means that the provinces have plenty to learn from one another.

But he said policy reform is in a state of gridlock — there is “a general reluctance to try new things to get more efficient services.”

Like others the court has heard from, he believed the prospects for improvement are stymied by vested interests.

His key message was other countries are delivering better universal health care more efficiently. In Canada, however, it’s too easy to duck responsibility and delay change.

The current discussions between the federal government and the provinces on a new Canada health accord are in stalemate.

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